Bonding Period

Column Editor’s Note: We gratefully acknowledge anthropologist Robbie Davis-Floyd for this contribution to The Powerful Parent-Infant Connection. It is from her path-breaking book, Birth as an American Rite of Passage (University of California Press, 1992). “Bonding Period” is a portion from the chapter “Messages” designed for the web by Ed Goldberg. The full chapter is at birthscene/messages. This article contains an in-depth discussion of the work of bonding pioneers Marshall Klaus and John Kennell as well as an overview of the concept of a “sensitive period” after birth. For more information about her ideas and writings, see her illuminating website.

Description and Official Rationale

There is no mention of bonding in the 984 pages of Williams Obstetrics, and only one short paragraph about “rooming-in” (1989:243). Nevertheless, most of the women in my study were handed their babies in the delivery room so that they could experience a short “bonding period,” usually after the babies had been washed, weighed, wrapped, and given their shots and their eye drops, but sometimes immediately after the birth. Bonding became part of normal birth routine in many hospitals due to the combined efforts of La Leche League and other childbirth activists, and to the concerted pleas of two pediatricians, Marshall Klaus and John Kennell. In Parent-Infant Bonding, first published in 1976, Klaus and Kennell point out the existence of a “sensitive period” immediately after birth during which maternal-infant attachment seems to occur much more readily than if mother and child are separated after the birth, as used to be standard hospital practice: “We believe that there is strong evidence that at least 30-60 minutes of early contact in privacy should be provided for every parent and infant to enhance the bonding experience” (Klaus and Kennell 1982:56).

Physiological Effects

Some researchers believe that there are no physiological effects of early bonding, that it is in fact a “scientific fiction” (Eyer 1992). On the other hand, proponents of bonding suggest that the physiological benefits of early “bonding” may be numerous. These potential benefits are eloquently summarized by Wenda Trevathan, who provides an exhaustive analysis of bonding research in Human Birth: An Evolutionary Perspective (1987:193-220):

Touching and massaging the infant stimulates breathing, provides warmth, and serves to rub the fatty vernix caseosa into the skin, which may prevent dehydration. If she holds it over her heart, on the left side of her body, the mother may be quieting the infant with the rhythmic beat that was an important part of its intrauterine environment. Holding it on the left may also facilitate eye contact, in that most infants prefer to turn their heads and look to the right….The infant may lick, nuzzle, or even suckle the mother’s breast in the immediate postpartum period. Nipple contact stimulates release of oxytocin into her bloodstream, which results in uterine contractions, expulsion of the placenta, and inhibition of postpartum bleeding. The colostrum that the infant ingests provides immunological protection and is the only natural source of Vitamin K, a substance essential for normal clotting of blood, necessary, for example, for preventing hemorrhage at the site of the umbilical cord. In addition, this early suckling may enhance later breastfeeding success.

Other benefits may possibly include growth of healthy maternal bacteria in the infant’s system, instead of the hospital bacteria she would have absorbed in the nursery (where strep and other bacterial epidemics are frequent occurrences), and “entrainment” of the bodily rhythms of mother and baby:

Detailed studies (Condon and Sander 1974) of the amazing behavioral capacities of the normal neonate have shown that the infant sees, hears and moves in rhythm to his mother’s voice in the first minutes and hours of life, resulting in a beautiful linking of the reactions of the two and a synchronized “dance” between the mother and the infant (Klaus and Kennell 1982:63).

Klaus and Kennell also stress that fathers who were observed interacting with their newborn infants went through the same sort of exploratory and synchronizing process as the mothers. Benefits to the infant of early bonding with parents involve taking advantage of the “quiet-alert state,” relatively rare in the first few days of life, which most normal newborns remain in for about 43 minutes immediately after birth, and in which rapid learning takes place. (Marshall Klaus postulates an evolutionary advantage to mothers and babies utilizing this period to get to know each other immediately after birth [personal communication], as does Trevathan [1987: 214-235].

Over the longer term, and more controversially, Klaus and Kennell postulate the value of uninterrupted bonding for the mother’s integration of her “mental picture” of the baby with the real child; they hypothesize an increased incidence of child abuse if such integration does not take place (1982:66-67). (The mental images held by mothers who batter their infants are often radically different in appearance and behavior from the actual child.) Long-term psychological benefits may include increased ease of parent-child relationships (O’Connor et al. 1978, 1980; Siegel 1982). There is some evidence to indicate that child abuse is statistically slightly more likely to occur when no opportunity for early bonding is provided, although good data are very difficult to procure. A well-controlled study of 301 mothers and babies (O’Connor et al. 1980) found a significantly decreased incidence of child abuse and neglect and parenting disorders among mothers who received 12 extra hours of contact with their newborns during the first two days after delivery. But it is important to note that other researchers have taken great issue with the research methods used in such studies (Amighi 1990; Eyer 1992; Lamb et al. 1985; Tronick et al. 1985, 1987). In fact, serious methodological problems with most of the bonding studies done to date have rendered them inconclusive in their attempts to demonstrate any long-term results of early bonding or of early maternal-infant separation (Laughlin 1990:43; Trevathan 1987:212).

Addressing earlier research on mammalian bonding behavior that seemed to indicate the biological necessity of immediate attachment, Trevathan concludes that

extremely rapid bond formation, such as has been described for goats and sheep, is “unnecessary” unless there is a good chance that the young will be mixed with others in the first few minutes or hours after birth. This is…certainly not the case for higher primates and human beings who live in groups too small for synchronous deliveries to be common and who have a level of awareness that would preclude great confusion over individual indentity during the postpartum period. Thus it is untenable to argue for a rapidly forming bond in most mammalian species including our own….[but] a strong and specific bond must ultimately form so that the mother is motivated to provide the high level of care needed by the helpless infant. Such attachment and motivation can develop in an adoptive mother as well, so neither the experience of parturition nor close biological relatedness is necessary for a strong mother-infant bond in human beings.

-Trevathan (1987:202)

Trevathan also notes that there are unusually high levels of endorphins present in mothers and infants during and immediately after delivery (1987:204); Odent (1984) suggests that these natural opiates contribute to maternal-infant bonding. Other researchers have also suggested that various hormones play roles in the maternal-infant attachment process, but, as Trevathan again points out, “Thousands of cesarean-delivered, bottle-feeding, and/or adoptive mothers offer proof of the ability of maternal solicitude to develop in the absence of hormonal precursors” (1987:205).

Women’s Responses

Jack helped cut the cord, and they gave the baby to me right away and never took him away from me. They wrapped him up and put him on my stomach and–they did not put the drops in his eyes immediately. He looked at me…I do feel that this baby has good eye contact with me. And I wonder if it’s because we looked into each other’s eyes for several minutes before the drops were put into his eyes. You know, before they get all blurry. I think that does make a difference.

-July Sanders

I had herpes, and they whisked the baby away to intensive care for observation and wouldn’t even let me touch him for three whole days. I grieved. I felt that he had died. Finally on the third day I went to the nursery and demanded him. But I felt very little when I got him. I know it’s nonsensical, but my emotional feeling was that he had died, and this was someone else. I wanted desperately to love him, and I knew that nursing would be the fastest way to make up for the bonding I had missed, so I made myself nurse him and I hated it for a long time. When I would sit down to nurse him I would feel so impatient I could scream. It took months for me to feel that I was really his mother, and he was really my baby. Finally it did happen, but it was awful for a long time.

-Jean Johnson

The miracle of the birth was so fantastic that I think I was in awe of the whole experience. It was beautiful and I’ll never forget it or lose the powerful emotion of it. The fact that my husband was there made it even more wonderful and he feels closer to me and his son because he helped and shared in the whole event, and we held our baby together. I don’t think any couple should have to be apart during labor and delivery if they have an alternative. I think that because we were together my postpartum depression has always been instead postpartum ecstasy and all my tears those of joy.

-Carmen Fisher, from her Lamaze story-report

They put the baby on my tummy but they told me not to touch it. They didn’t want my hands down anywhere near there….then they took it away, and I just turned off like a clam. It was awful….I didn’t want to have anything to do with it….I finally told my mother–she was the only one I felt I could admit it to–I just came out and told her that I just wanted to give it away. It sounds terrible but it was an honest feeling. It was six weeks before I felt like I really loved him….And now I wouldn’t part with him–he’s great. Well and the next time–it was really weird. I put my hand down on him and I didn’t expect to feel that way, I thought well it won’t be as bad as last time but you know it might take some time to get to love him. But the second he came out, they put him on my skin and I reached down and I felt him and it was something about having that sticky stuff on my fingers….it was like gosh, it’s almost like part of him or something– I don’t know what it was but it was really important to feel that waxy stuff….and they covered him up and he was crying and I made soothing sounds to him….and he started calming down and somehow that makes you feel–like he already knows you, he knows who you are–like animals or something, perhaps the smell of each other….but it was marvelous to hold him and I just touched him for a really long time and then they took him over but something had already happened. But it was much more than I ever felt or thought I would feel. Just instant love. And I can remember when they would bring him into the room afterwards–it didn’t diminish at all. It just always seemed to be there–I was crazy about him right from the beginning.

-Anne Mallone

Ritual Purposes

Throughout most of human history, mothers and babies have stayed together after birth. 12 It would seem that today’s “bonding period” might simply represent a commonsensical return to a formerly universal human practice, but few human customs are that straightforward. Although birthing women are no longer routinely put to sleep, institutional interests are still better served when mothers and babies are separated (see below), so general acceptance of the importance of a bonding period has been far from automatic.

Since the original research on bonding in the 1970s, a great deal of controversy has erupted over the long-term effects of this simple practice. Many medical personnel, and many mothers, felt that Klaus and Kennell were “way off base” to suggest that when mothers missed this “sensitive period,” their relationships with their babies had somehow been impaired. Yet proponents of bonding theory have consistently stressed that, even if the initial contact is not experienced, long-term attachment can and usually does occur. A primary goal of the publications by these two pediatricians was to eliminate (1) the practice of denying new parents of premature babies access to intensive care units; (2) the whisking away of all babies to the nursery immediately after birth; (3) the practice of keeping parents and even healthy newborns separated for hours after birth. All these were standard procedure in most American hospitals before the research of Klaus and Kennell on the attachment process–and that of many others–gained such wide recognition. Their point has been that this initial contact in the sensitive period facilitates, but is not essential to, the development of a strong maternal-infant attachment:

Some misinterpretations of studies of parent-to-infant attachment may have resulted from a too literal acceptance of the word bonding and so have suggested that the speed of this reaction resembles that of epoxy materials….The human is highly adaptable, and there are many fail-safe routes to attachment. Sadly, some parents who missed the bonding experience have felt that all was lost for their future relationship. This was (and is) completely incorrect.

-Kennell and Klaus 1989:281

Social scientists Arney and Martin present interpretations of bonding that deplore its ideological underpinnings. Arney feels that bonding, “like so many other ideologies that pose as social theories, turns social issues into individuals’ problems” because it “lends legitimacy to the notion that women are the only appropriate attendants for children” and so justifies keeping women at home (1982:171).

Martin suggests that the focus on bonding diverts our attention from how the whole process of birth has been sundered by the application of the production metaphor. To put it baldly, if a worker feels lack of involvement with a product when she does not feel she made it and when her work is regimented and controlled, think how a woman would feel if in her view her baby’s birth was taken away from her by the exertion of control over her body? Surely restoring contact between mothers and babies immediately after birth could not restore automatically a sense of engrossment with the baby when the process of birth has been so deeply interrupted. (1987:86)

Yet the statements of the women in my study indicate that it can and often does restore such a sense–perhaps in part because that sense is not new. Birthing mothers–and fathers–have been “bonding” with their babies for months before birth in myriad ways. The strength of this prenatal bond is indicated by the devastation both parents can experience when they miscarry or choose to abort:

For two weeks, Mike and I breathed as one person. His distress, loss and concern were never one whit less than my own. But we were sometimes upset and angered by unconscious cultural attitudes which precluded acknowledgment of his loss. He was expected to “cope,” while I was nurtured through my “need.” We’ve struggled for male responsibility in birth control, sexual mutuality, childbirth and childrearing, and I think we need to acknlowledge that those men who do engage in such transformed practices have mourning rights during a pregnancy loss as well. And yet, having spent fifteen years arguing against biological determinism in my intellectual and political life, I’m compelled to recognize the material reality of this experience. Because it happened in my body, a woman’s body, I recovered much more slowly than Mike did. By whatever mysterious process, he was able to damp back the pain and throw himself back into work after several weeks. For me, it took months. As long as I had the 14 pounds of pregnancy weight to lose, as long as my aching breasts, filled with milk, couldn’t squeeze into bras, as long as my tummy muscles protruded, I was confronted with the physical reality of being post-pregnant, without a child. Mike’s support seemed inadequate. I was in deep mourning while he seemed distant and cured.

-Rapp 1984:323

The intensity of grief Rapp experienced–biological, psychological, and social–is mirrored by the intensity of joy–biological, psychological and social–that parents experience when they hold their newborn babies. Marshall Klaus reports that in the early work on bonding that he and others carried out:

We put the mother, when she was ready, in a private room after the birth with plenty of heat provided. There she spent uninterrupted time alone with the baby. We found from studying the videotapes we made that the mother’s behavior when alone with the baby differed radically from her behavior when handed the baby in a crowded and busy delivery room for “bonding.” For example, on the videos we saw lots of mothers gazing at their babies and saying, “Look into my eyes,” which we did not observe them doing in the delivery room. The 10-minute bonding period was the result of an AMA meeting in the 1970s to which we were not invited. It was never our intention to institutionalize 10 minutes–the whole thing very quickly got taken out of our hands. (personal communication).

As Klaus indicates, the routinization of “here’s your baby–now bond!” demonstrates the rapid ideological co-option of attachment theory by institutional interests: it directly conveys the message that society gives the baby (produced by its technology) to the mother. At the same time, the handing of the baby to the mother constitutes a powerful ritual acknowledgment on the part of society that she is now a mother, that her transformation is complete: that the child she carried, nurtured, and loved inside her for so long is now in physical union with her in a new and thrilling way. As the statements of the women in my study and Rapp’s eloquent testimony make clear, there are emotions involved in the “bonding” process that are simply not co-optable. Even if bonding as ideology serves patriarchy (Arney 1982) or the economic interests of the hospital (Eyer 1992), or fails to redress the wounds of the baby’s technological production (Martin 1987), bonding as experience offers profound joy and meaning to mothers, fathers, and babies.

Immediately after birth, the mother is still physically and psychologically at her most open. Her baby constitutes for her a powerful symbol of her motherhood, her individuality, her new family, the beauty and wonder of nature, and the perfection of her own body and her procreative powers. To hold, touch, gaze at her newborn unhindered is to internalize these messages, to incorporate her newborn through all her sensory channels into the transformed identity with which the mother will emerge from her initiation experience. Often this bonding experience is powerful and positive enough to entirely override, in the mother’s conscious perception of her birth experience, any negative feelings of powerlessness, humiliation, or pain she may have been experiencing before her baby’s birth.

The presence of the father at these very special moments of highest affectivity ensures that he too will be incorporated into the mother’s new sense of her identity, and she and the baby into his. True bonding, when it is allowed to occur in the hospital, conveys an extremely potent message of the integrity and worth of the family in relation to science, technology, patriarchy, and institutions–a message so powerful that it will often override all others in both parents’ memories of their birth. Given the perceived threats to the American family as the fundamental social unit posed by the high divorce rate, it would seem to be in society’s interest to foster this process, send this message. As with the routinization of father’s presence in the delivery room, routine bonding, insofar as it strengthens the beleaguered American family, strengthens society as well.

Nevertheless, some recent research that denies anything special about the period immediately after birth (Lamb 1982, 1983; Lamb and Hwang 1982; Myers 1984) is now being used to undo the work of the 1970s, so that in some hospitals that used routinely to provide such a period of togetherness, the baby is once again whisked away. The readiness of such institutions to do away with the bonding period seems to reflect an acknowledgment of its symbolic and psychological mystique and power. As I stated above, the symbolic ramifications of bonding are profound for both the mother and the father: all the efforts at conceptual separation of mother-machine from child-product made in hospital birth rituals can be completely undone in the mother’s psyche at that integrating contact. Time and again I heard women describe highly technocratic labor experiences that were alienating up until the moment of birth as “positive” and “wonderful” because of the intensity of the joy they experienced upon touching and gazing at their newborn babes.